Concurrent versus terminal feedback: The effect of feedback delivery on lumbar puncture skills in simulation training

Abstract

Introduction

Simulation-based medical education (SBME) is widely used to teach bedside procedural skills. Feedback is crucial to SBME but research on optimal timing to support novice learners’ skill development has produced conflicting results.

Methods

We randomly assigned 32 novice medical students to receive feedback either during (concurrent) or after (terminal) trialing lumbar puncture (LP). Participants completed pre- and post-acquisition tests, as well as retention and transfer tests, graded on a LP checklist by two blinded expert raters. Cognitive load and anxiety were also assessed, as well as learners’ perceptions of feedback.

Results

Participants who received concurrent feedback demonstrated significantly higher LP checklist scores (M = 91.54, SE = 1.90) after controlling for baseline levels, than those who received terminal feedback (M = 85.64, SE = 1.90), collapsed across post, retention, and transfer tests. There was no difference in cognitive load and anxiety between groups. In open-ended responses, participants who received concurrent feedback more often expressed satisfaction with their learning experience compared to those who received terminal feedback.

Discussion and conclusions

Concurrent may be superior to terminal feedback when teaching novice learners complex procedures and has the potential to improve learning if incorporated into SBME and clinical teaching. Further research is needed to elucidate underlying cognitive processes to explain this finding.

Keywords:

• Feedback
• clinical skills
• learning outcomes
• simulation

Acknowledgments

The authors thank Dr. Anita Lau (MD), Zhuo Qian Cao (BSc), Natasha Willis (RN, MScN), Marwa Ibrahim (BA/BSc), Zack van Allen (MA, MBA), and Trisha Long (PharmD candidate) for their assistance in data collection for our study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by Ontario Medical Students Association Medical Student Education Research Grant.

Notes on contributors

Anna Liu

Anna Liu is currently completing her training in Endocrinology and Metabolism after completing her Internal Medicine training at Western University. She completed medical school at the University of Ottawa. Her interests lie in medical education, both from a teaching and research perspective.

Melissa Duffy

Melissa Duffy is an assistant professor at the University of South Carolina. She completed her Master of Arts followed by PhD in Educational Psychology at McGill University. Her research interests lie in medical education, focusing on the role of emotions and motivation in learning and performance.

Sandy Tse

Sandy Tse is a Pediatric Emergency Medicine specialist. She completed her pediatrics residency at the University of Alberta, followed by a pediatric emergency medicine fellowship and Health Education Scholars Program at the University of Ottawa. She is the Director of Competence-Based Medical Education for Pediatrics at the University of Ottawa.

Marc Zucker

Marc Zucker completed his pediatrics residency training at the University of Calgary. He is the Director of Clerkship, Anglophone Stream, and co-lead for the Transition to Residency course at the University of Ottawa. Dr. Zucker has a clinical interest in children with 22q11.2 Deletion Syndrome and hospital-based pediatric medicine.

Hugh McMillan

Hugh McMillan is a Pediatric Neurologist and Neuromuscular specialist. He completed a Neuromuscular Fellowship at Harvard University, Neurophysiology Fellowship at Tufts University, Pediatric Neurology Residency at the University of Ottawa, and Pediatric Residency at McMaster University. He is active in clinical and translational research along with research in medical education.

Patrick Weldon

Patrick Weldon is a Pediatric Emergency Medicine Specialist. He completed his Pediatrics residency, Pediatric Emergency Medicine fellowship, and Health Education Scholars Program through the Department of Innovation in Medical Education at the University of Ottawa. He is actively involved in medical education with particular interest in Simulation Based Medical Education.

Julie Quet

Julie Quet is a General Pediatrician at the Children’s Hospital of Eastern Ontario. She completed her Pediatric residency at the University of Ottawa. She has a keen interest in medical education and is currently the OSCE lead for the University of Ottawa Pediatric Residency program.

Michelle Long

Michelle Long completed her medical training at the University of Saskatchewan and both her Pediatrics residency and Pediatric Emergency Medicine fellowship at the University of Ottawa. She is extensively involved in medical education and has a strong interest in patient safety/quality improvement initiatives.